Healthcare Provider Details

I. General information

NPI: 1417907502
Provider Name (Legal Business Name): CENTRO DE SALUD DE LARES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 111 KM 1.9 LOS PATRIOTAS AVE.
LARES PR
00669-0379
US

IV. Provider business mailing address

PO BOX 379
LARES PR
00669-0379
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-2727
  • Fax: 787-897-2725
Mailing address:
  • Phone: 787-897-2727
  • Fax: 787-897-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberCNC99-285
License Number StatePR

VIII. Authorized Official

Name: DAMARIS RODRIGUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-897-2727